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PubMed2006

[A case of primary neuroendocrine carcinoma of liver presenting with liver abscess].

Primary hepatic neuroendocrine cell carcinoma is a very rare tumor. We experienced a 75-year-old woman with primary hepatic neuroendocrine carcinoma presenting with pyogenic liver abscess. Abdominal CT scan revealed a multiseptated liver abscess and an enlarged lymph node in portocaval portion. We performed percutaneous drainage of the liver abscess, but the amount of drained pus did not decrease after 20 days. The follow-up abdominal CT scan showed that the cystic portion of liver abscess had been replaced by the solid tumor. Microscopic examination of the tumor tissue showed nests of epithelial cells with uniform round hyperchromatic nuclei and high nuclear to cytoplasmic ratio. Immunohistochemical staining was strongly positive for synaptophysin and chromogranin A.

Aged↗
PubMedDate not supplied

Pyogenic liver abscess in beta-thalassemia major--report of two cases.

Pyogenic liver abscess, which may lead to devastating consequences, is an uncommon medical problem in pediatrics and has generally been reported in compromised hosts. This article describes two patients with beta-thalassemia major and hemochromatosis complicated by Klebsiella pneumoniae liver abscess. One of the patients had severe complications, including subphrenic abscess, pleural effusion and meningitis. To present knowledge, the occurrence of K. pneumoniae liver abscess in patients with beta-thalassemia major has never before been reported in the literature.

Adult↗
PubMed2002

Spontaneous gas-forming liver abscess caused by Salmonella within hepatocellular carcinoma: a case report and review of the literature.

In conclusion, pyogenic liver abscess in hepatocellular carcinoma is unusual. Most of the reported cases occurred after a treatment such as transcatheter arterial embolization or percutaneous ultrasound-guided ethanol injection. Salomonella very rarely causes pyogenic liver abscesses. Only 14 cases have been reported in the English literature since 1911. Salmonella liver abscess occurring within a primary neoplasm is even rarer. There were only two such cases described in patients with hepatocellular carcinoma before. The present case is the third one, but it may be the first case of obvious spontaneous gas-forming liver abscess caused by Salmonella within hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1976

Syndromes in amoebic liver abscess.

A series of 137 patients with amoebic liver abscess has been studied. Recognition of clearly defined but diverse clinical syndromes was found to be necessary not only in diagnosis but also in planned surgical management. The majority of patients had the classic syndrome of fever, right abdominal or chest pain, hepatomegaly, hepatic tenderness and radiological abnormalities. Other syndromes of presentation included the silent abscess, acute amoebic colitis, the acute abdomen, the intraabdominal lump, the external sinus, pyrexia of obscure origin, obstructive jaundice and renal, pleuro-pulmonary and cardiac symptoms. The syndromes due to an abscess in different parts of the right lobe and in the left lobe of the liver are to some extent distinct. In spite of the varied modes of presentation of amoebic liver abscess, the key to diagnosis is an understanding of the chronological sequence of the disease and its progression from one syndrome to another. Diagnostic methods of value and the mortality are discussed.

Abdomen, Acute↗
PubMed1993

Clinico-therapeutic profile of pyogenic liver abscess.

Nineteen consecutive patients of pyogenic liver abscess (13 males, 6 females, mean age 45.2 +/- 6, 5 years) were studied over a period of 5 years for the clinical profile and therapeutic efficacy of percutaneous aspiration. Majority of them presented with spiking fever (94.7%), pain over right upper quadrant of abdomen (53.8%) and often with prostration and shock (31.6%). The onset has been rather acute in patients with multiple abscesses (7 cases). Ascites (10.5%), clubbing of fingers (15.8%) and splenomegaly (10.5%) were observed in cases with long duration of illness. There has been the polymorphonuclear leucocytosis (89.5%) and mild to moderate anaemia (52.6%). Jaundice (42.1%) was usually mild degree (serum bilirubin 4.6 +/- 2.4 mg/dl). The serum transaminases and alkaline phosphatase were raised in 94.9% of cases. Ultrasonography revealed predominantly hypoechoic (54.1%) areas with frequent distal acoustic enhancement and internal echoes (21.6%). Seven patients had multiple abscesses with 25 lesions (size 5.2 +/- 4.6 cms) situated mainly over antero-inferior segment of the right lobe (45.9%) of the liver. The blood and pus cultures demonstrated the micro-organisms (positive in 63.9% and 86.6% respectively) predominantly of bowel flora including facultative gram negative rods and anaerobes. Mortality was 26.5% and pleuro-pulmonary complications were the commonest (26.4%) one. 15 cases were treated by percutaneous aspiration, proper antibiotic and metronidazole with encouraging results (only two deaths). Complete resolution of abscess took place in 14.2 +/- 1.2 weeks (range 6 weeks to 7.5 months). It is emphasized that percutaneous needle aspiration is useful both for diagnosis and treatment of pyogenic liver abscess.

Adolescent↗
PubMed1979

Liver abscess. A complication of regional enteritis.

A patient with liver abscess in association with regional enteritis is reported. Liver abscess should be suspected in patients with regional enteritis who present with fever, elevated serum alkaline phosphatase, liver tenderness, right upper quadrant pain or hepatomegaly.

Alkaline Phosphatase↗
PubMed1986

[Pyogenic liver abscess].

27 patients who presented with pyogenic liver abscess from 1957 to 1984 are analyzed retrospectively and compared with the literature. Diagnosis and start of therapy were frequently delayed because of the unspecificity of symptoms. Symptoms included fever, abdominal pain, weakness, and loss of weight. In 50% of all patients, the abscess was found by chance at laparotomy or autopsy. The most frequent causes of abscess formation were cholestasis due to extrahepatic obstruction and intraabdominal infections. Frequently a predisposing condition such as carcinoma, diabetes mellitus or alcohol abuse was found. The overall mortality was 25%, and was higher in patients with multiple abscesses of the liver (36%) than in patients with solitary abscesses (10%). With the introduction of new imaging procedures (ultrasound, computer tomography), the abscesses can be punctured under view and the antibiotic therapy can be based on bacterial analysis. The causative bacterial organism could be identified by cultures of the abscess fluid and blood in up to 90%. The bacteria identified usually were identical to the intestinal flora. Using specific antibiotic therapy, surgical treatment is often unnecessary and can be reserved for abscesses resistant to conservative treatment and for those due to correction of the original source of abscess formation.

Adult↗
PubMed1991

[Liver abscess caused by Aeromonas hydrophila].

Because of the rare incidence of liver abscess in childhood and of extremely rare observed Aeromonas hydrophila as pathogen of such a disease we report on a 14 7/12 year old girl with a liver abscess. For the last 4 years she had to be enrolled in chronic hemodialysis. The treatment comprised opening of the abscess cavity and drainage, and antibiotic therapy with cefotiam. We were unable to isolate Aeromonas hydrophila in the environment of the hemodialysis center. Some aspects of clinical importance of liver abscess in childhood and of Aeromonas spp. as pathogens in human infections are discussed.

Adolescent↗
PubMed2000

Diagnosis of amebic liver abscess and intestinal infection with the TechLab Entamoeba histolytica II antigen detection and antibody tests.

A noninvasive diagnostic test for amebic liver abscess is needed, because amebic and bacterial abscesses appear identical on ultrasound or computer tomography and because it is rarely possible to identify Entamoeba histolytica in stool specimens from patients with amebic liver abscess. Here we report a method of detection in serum of circulating E. histolytica Gal/GalNAc lectin to diagnose amebic liver abscess, which was used in patients from Dhaka, Bangladesh. The TechLab E. histolytica II test (which differentiates the true pathogen E. histolytica from Entamoeba dispar) detected Gal/GalNAc lectin in the sera of 22 of 23 (96%) amebic liver abscess patients tested prior to treatment with the antiamebic drug metronidazole and 0 of 70 (0%) controls. After 1 week of treatment with metronidazole, 9 of 11 (82%) patients became serum lectin antigen negative. The sensitivity of the E. histolytica II antigen detection test for intestinal infection was also evaluated. Antigen detection identified E. histolytica infection in 50 samples from 1, 164 asymptomatic preschool children aged 2 to 5 years, including 16 of 16 (100%) culture-positive specimens. PCR analysis of stool specimens was used to confirm that most antigen-positive but culture-negative specimens were true-positive: PCR identified parasite DNA in 27 of 34 (79%) of the antigen-positive, culture-negative stool specimens. Antigen detection was a more sensitive test for infection than antilectin antibodies, which were detected in only 76 of 98 (78%) amebic liver abscess patients and in 26 of 50 (52%) patients with intestinal infection. We conclude that the TechLab E. histolytica II kit is a sensitive means to diagnose hepatic and intestinal amebiasis prior to the institution of metronidazole treatment.

Adult↗
PubMed1980

Effect of Trichinella spiralis infection on the experimental amebic liver abscess in hamsters.

The development of experimental amebic liver abscess in hamsters was inhibited by a previous infection with the nematode parasite Trichinella spiralis, such that liver abscesses were present in 26% of hamsters with T. spiralis infection and in 80% of T. spiralis-free controls. The protective effect of T. spiralis infection is believed to be exerted through a non-specific activation of cellular immunity, with macrophages as probable effector cells.

Animals↗
PubMed2004

Non-septicemic Burkholderia pseudomallei liver abscess in a young man.

Melioidosis, caused by Burkholderia pseudomallei, has been increasingly recognized in Taiwan recently. Its isolation in liver abscess is rare compared to pulmonary melioidosis. We report a case of liver abscess due to B. pseudomallei in an immunocompetent 27-year-old male soldier admitted due to fever, sore throat and mild non-productive cough for 1 week. Physical examination was unremarkable except for congestion of the pharyngeal wall, moderate enlargement of the tonsils without pus coating, and palpable tender lymphadenopathy over bilateral submental regions. Antibiotic treatment with cefazolin 1 g every 8 hours intravenously was given without response. Left flank pain, followed by right flank pain associated with epigastric tenderness developed. Sonography and computed tomography scan of the abdomen demonstrated liver abscess. Aspiration of the liver abscess was performed and abscess culture yielded B. pseudomallei. Treatment with ceftazidime 2 g every 8 hours intravenously (4 weeks' duration) followed by oral regimens of amoxicillin-clavulanate was given. The patient was free of symptoms at 8 months' follow-up. Early awareness and definite diagnosis as well as institution of proper antimicrobial agents are imperative for successful treatment of melioidosis.

Adult↗
PubMed2004

Laparoscopic drainage of pyogenic liver abscesses.

PURPOSE: To report our experience of performing laparoscopic drainage of liver abscesses in patients who failed to respond to conservative treatment. METHODS: We retrospectively compared the results and complications of 18 patients who underwent laparoscopic liver abscess drainage with those of 5 patients who underwent open drainage between June 1999 and October 2002. RESULTS: The operation times were shorter and oral intake was recommenced earlier in the laparoscopic group, which also tended to have less blood loss and shorter hospitalization. One case of recurrence, which developed 1 month postoperatively, was successfully treated with percutaneous drainage. There was no mortality in either group. CONCLUSION: Laparoscopic drainage of liver abscesses, combined with intravenous antibiotics, is a safe alternative for patients requiring surgical drainage when medical treatment has failed.

Aged↗
PubMedDate not supplied

[Liver abscess: is drug therapy only possible?].

We describe a case of liver abscess, whose favourable evolution, after the initial medical treatment, started when we didn't know the diagnosis, persuaded us to continue the begun treatment, based on localization of disease and on clinical improvement, instead of carrying out on evacuative puncture. At moment, according to our knowledge, this is the third case of liver abscess which has recovered by on antibiotic rational treatment without surgical punctures. Can we treat the liver abscess like the pneumonia according to features of localization and clinical history?

Ceftazidime↗
PubMed2005

Solitary liver abscess in a healthy child presenting with fever of unknown origin.

Pyogenic liver abscess is rarely encountered in normal children. We report a case of solitary pyogenic liver abscess in a healthy child aged 8 months. He presented with fever of unknown origin and mild hepatomegaly. Full recovery was achieved by surgical intervention and prolonged antibiotic treatment. Management and recommended treatment in children with liver abscess are presented.

Fever of Unknown Origin↗
PubMedDate not supplied

[Liver abscess and HIV: report of a case].

The association of a liver abscess of possible amebic etiology with HIV in a Cuban patient that worked in the Republic of Ethiopia was described. This is important because during the time elapsed since the HIV was described, multiple opportunistic infections were reported, some of them capable of giving rise to the formation of liver abscesses, but none of them with an amebic etiology. In addition, this patient was the first case of liver abscess of possible amebic etiology reported in the whole population of HIV (+) patients studied at "Pedro Kourí" Institute of Tropical Medicine.

Adult↗
PubMed1988

Pyogenic liver abscess: an improvement in prognosis.

Forty-six patients with pyogenic liver abscess have been treated at Paul Brousse Hospital between 1966 and 1986. The overall mortality was 24 per cent, all 11 deaths occurring in 24 patients seen prior to 1978 when there was often a considerable delay in the diagnosis of liver abscess (mean 90 +/- 71 days). In seven patients the diagnosis was not made until post-mortem examination. The mainstay of treatment was surgical drainage. Since 1978 high resolution imaging techniques for the liver, and in particular ultrasound, have been available. The diagnostic delay has been significantly reduced (mean 28 +/- 20 days, P less than 0.01). Patients are receiving definitive treatment at an earlier stage in the evolution of the disease process, with fewer established complications prior to treatment (P less than 0.05). Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high-risk patients. There have been no deaths in 22 patients treated for pyogenic liver abscess since 1978 (P less than 0.001).

Aged↗
PubMed2003

Liver abscess of hydatid origin: clinical features and results of aggressive treatment.

BACKGROUND: Cyst infection and subsequent liver abscess formation are complications of liver echinococcosis. Traditionally, this condition has been treated by simple drainage, a procedure associated with unsatisfactory postoperative evolution. METHODS: The present paper examines a series of cases involving infected liver echinococcal cysts. Surgery was performed at the Temuco Regional Hospital after assessment was made of general and liver laboratory parameters, chest X-ray and abdominal ultrasound were performed and antibiotic treatment was administered. The procedure consisted of surgical drainage, parasite material extirpation and pericystic membrane resection with surrounding healthy liver parenchyma. The morbidity and mortality rate, hospital stay and evidence of recurrent hydatid disease were evaluated. RESULTS: Forty-nine patients (21 male and 28 female), with a median age of 45 years (range 16-84 years), with infected cysts measuring 14 cm in ultrasonographical diameter (range 5-30 cm) were operated on. In the majority of cases, liver abscesses were located in the right lobe (37 patients, 75.4%) and the most frequent computed tomography scan pattern was heterogeneous (40 patients, 81.6%). The median hospital stay was 5 days, the median follow-up period was 32 months (range 2-91 months) and perioperative morbidity was 24.4%. Surgical complications were verified in five patients (10.2%) and medical complications occurred in seven cases (14.3%). No recurrence of hydatid disease was observed. Mortality was 2% (one patient). CONCLUSIONS: Good results were obtained when hydatid liver abscesses were treated aggressively.

Adolescent↗
PubMed2001

Single and multiple pyogenic liver abscesses: etiology, clinical course, and outcome.

BACKGROUND: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. METHODS: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. RESULTS: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. CONCLUSIONS: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

Aged↗